Medical Ethics Midterm

Immanuel Kant’s Categorical Imperative (steps)

Turn your proposed action into a maxim: “I am going to steal the drugs from the pharmacist
because my wife needs them.” (This is the action you are evaluating in each of the following three tests)

Three tests
1. Can you will that your proposed action (maxim) be made into a universal law that all rational
beings must follow? “All rational beings should steal what they need.”

2. Are you using ‘humanity’ (yourself or another person) merely as a means to an end? “I am
going to ‘use’ the pharmacist (the means) to save my wife (the end).”

3. In taking your action, will you be acting in accordance with your duty by 1) adhering to the
universal law and 2) not using yourself/another merely as a means to an end?

This FAILS

1)Since I cannot ‘will’ that everyone should steal what they want

2)and because I would be using the pharmacist merely as a means to an end, taking this action would not be in accordance with duty.

NOTE: A complete answer when using Kant’s Categorical Imperative must include all
three tests!

Use the categorical imperative on the following example 

Imagine you have promised a friend that you would help them move, but on the day of the move, a better opportunity comes up (e.g., an invitation to a concert or a job interview). You consider breaking your promise to your friend to pursue the new opportunity. Is breaking the promise morally permissible according to Kant's Categorical Imperative?

1) Turn into a maxim— “I am going to break the promise to my friend to pursue a better opportunity”

2)Formulation 1: Universal Law— “All rational beings ought to break promises” 

Fails this first formulation since breaking promises undermines them, and would not work in a society where everyone broke them.

We should rewrite a new maxim— “Do not make promises you cannot keep” or “Do not break promises”

3)Formulation 2: Humanity

Fails since you are breaking a promise to them for your convenience, which is using them as an end.

4)Formulation 3: Kingdom of Ends

Does the original action work with your rewritten maxim? 

Fails, breaking a promise violates the rewritten Maxim

**The maxim has to only fail one test to be considered not moral, but a complete answer adresses all 3

perfect duty

duty that one must always observe and from which there are no exceptions. It is a duty that can be universalized without contradiction. Examples include duties not to lie, not to kill, and not to break promises.

imperfect duty

duty that one must observe only on occasion, rather than constantly. It allows for latitude or discretion in how and when it is fulfilled. Imperfect duties cannot be universalized without contradiction if you were to will that no one ever perform them, but they do not require every person to perform them at all times. Examples include duties to develop one's talents or to help others in need (beneficence).

ex: studying

Kant’s rules on imperfect vs perfect duties

the perfect duties will ALWAYS outweigh imperfect duties

utilitarian theories

for ALL types CONSEQUENCES are the most important

Act utilitarianism

Jeremy Bentham(egalitarian)

the morally correct action is the one that has the greatest utility

quantity over quality

ex: saving a group of people rather than just one

Strong rule utilitarianism

John Stuart Mill

moral rules that generally produce the most utility in the long run 

quality over quantity

ex: saving one person over a group of people, because of the rule “save a life if you can”/ produces most utility in long run, but in that moment it might not be the “best” choice

Mill’s Harm principle

The only purpose for which power can be exercised over any member of a civilized community against his will is to prevent harm to OTHERS. His own good is not a sufficient warrant.

Weak rule utilitarianism

RM Hare

When there are clashing rules choose the rule that produces overwhelmingly more utility

ex: saving a group of people over one person

the strong rule utilitarian would choose the one

the act utilitarian would choose the group

the weak rule would also choose GROUP because more utility seems to be produced overall

preference utilitarianism

Peter Singer

Choose the action that will satisfy the greatest number of preferences of all parties concerned

ex; choosing the group over one person because the people all have an interest in living compared to the one interest of person in living

**weights preference of ALL sentient beings, including animals 

Strong rule utilitarian and Deontologists would generally pick the same choices, but their reasons differ. What are these reasons?

Strong rule—"Im going to save a life, because generally trying to save a life produces the best OUTCOME”

deontologist—”I am going to save a life because I need to ACT in accordance with duty” 

Act utilitarians and and Preference utilitarians would choose the same decisions, but for different reasons. What are these reasons?

Act— “More lives are saved, so more utility is produced”

Preference— “More people have a preference to live so I have to satisfy those”

kantian stance on the use and treatment of animals

Since animals are not considered rational beings they may be used as a means to an end 

however, they should not be abused or harmed 

Theories of justice

what is valuable?

equality

what is the right action?

Defining equality and taking any action that supports that

The principle of formal equality

Aristotle

“Equals must be treated equally”

Governs a society’s distribution of resources

-to each an equal share—divide resources evenly

-to each according to need—prioritize patients by need

-to each according to effort/contribution—prioritize those who contribute the most

-to each according to fair market exchanges—priortiize by abilty to pay or set rules not encumbered by gov reg

moral nihilism

we have no obligations to others, or actions. Only obligations to ourselves

Kantian contractarianism

John Rawls

people matter bc they are ENDS

since everyone is a rational being, they are entitled to equal consideration—we have a natural duty to promote just society

Rawlsian/Kantian contractarian “formula” for creating a just society

Basic social principles should be derived from the standpoint of the ‘original position’ (we know nothing about the characteristics of anyone else in society)

Therefore, just principles should be developed behind a “veil of ignorance” (making decisions based on not knowing ones own characteristics so they dont advantage themselves)

2 basic principles would be drawn—liberty and equality

difference principle

All goods shall be equally distributed except where an unequal distribution would make the least well off better off

everyone should have an equal chance to achieve various roles in society

what would justice look like to a utilitarian?

distribution must produce the most positive value over disvalue

if there is not a positive result, must produce least amount of disvalue

the ends justifies the means(group value over individual)

what does justice look like to a libertarian?

To each person a maximum of liberty and property resulting from the exercise of liberty rights and participation in fair market exchanges

if goods belong to someone, its immoral to take them away

individual liberty is important

libertarian utilitarianism

a philosophy that argues that libertarian principles(individual rights) are the most effective way to maximize happiness in the long run

uses rule-based utilitarianism

principles of allocation

1) treating people equally 

-lottery

-first come first serve 

2)Prioritarianism—protecting worst off

-sickest first

-youngest first 

3)Maximizing benefits—utilitarianism 

-save the most lives

-Prognosis 

-QALYS—try to save people based on healthy life years

-DALYS—minimize all of these

4)Promoting and rewarding social usefulness 

-Instrumental value

-Reciprocity (Rewards past usefulness-past organ donors, etc)

Natural Law Theory

Thomas Aquinas

“the law inscribed by God into the nature of things”

We should desire things that are good because they are inherently good, not because of desires

our ability to reason enables us to actively participate in God’s plan

Components of Natural law theory

Eternal law—God’s plan and purpose for ALL

Something is “good” as long as it fulfills its plan(for humans its to reason)

Naturall Law—We know to just follow it

1)Primary precepts—if we all reason we will all agree on the same rules that are ALWAYS true 

2)Human Law(secondary precepts)—not generated by reason, but rather society’s rules; not always morally acceptable 

-apprent good-something seems good, but is not; does not follow NL

-real good-something that is good and follows NL

Divine Law-rules given to us by God

-guides humans since some people might ration their way towards “bad actions” 

-ex: ten commandments 

Doctrine of Double Effect

Aquinas says an action is not just about WHAT we do but WHY we do it

MUST fulfill ALL 4 rules

1)The act must be a good one/morally neutral

2)The act must come before bad effects

3)The intention behind the act must be good

4)Must be for serious reasons

Lets apply the doctrine of double effect

A pregnant woman develops a life‑threatening case of uterine cancer. In order to save her life, her doctor decides to perform a hysterectomy, the surgical removal of the uterus.

1)The action itself is good because it is saving someone’s life 

2)The mother’s life is saved by removing the uterus, which comes before killing the fetus 

3)The intention is good because it is to save someone’s life 

4)The reason is serious  since it concerns someone’s life 

The action is morally permissible

virtue ethics

Aristotle

emphasize character over conduct

Aristotle’s function argument

all objects have a telos

an object is good when it does that

humans telos is to reason(similar to Aquinas)

eudaimonia—”flourishing”

the state when we achieve a full and good life

the state that all humans should try to reach

to reach it, we must act in accordance with reason and stimulate the mind

virtues

according to Aristotle are personality traits 

phronesis

practical wisdom we seek to acquire throughout our lives

we practice virtues to reach eudaimonia

The virtuous act

A virtuous act done for the wrong reasons(being observed) does not make one a virtuous person

a person strengthens a virtue by practicing it all the time, even when it is difficult to do so

virtues are considered stable, and unchanging

when is a person morally responsible for failing to act in a virtuous way?

voluntary actions

-freely chosen 

-actions in ignorance 

-actions in ignorance w/o regret 

involuntary

-actions that one does bc of external physical force

-actions that one does bc of external psychological force

-actions in ignorance w/ regret

Aristotle’s golden mean

too much or too little of a virtue can be bad, it needs to be “middle”

ex: too much courage can make one rash, too little can make one a coward

communitarianism

what is good for the community

ubuntu

community is what humanity lives for